Soluble Urokinase Plasminogen Activator Receptor as a Decision Marker for Early Discharge of Patients with COVID-19 Symptoms in the Emergency Department

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

  • Marius Ahm Stauning
  • Izzet Altintas
  • Thomas Kallemose
  • Jesper Eugen-Olsen
  • Mette Bendtz Lindstrøm
  • Line Jee Hartmann Rasmussen
  • Hejdi Gamst-Jensen
  • Jan O. Nehlin
  • Andersen, Ove
  • Jens Tingleff

Background: Severe acute respiratory syndrome coronavirus 2 (The Covid-19 pandemic) strains health care capacity. Better risk stratification, with discharge of patients with a predicted mild disease trajectory, can ease this burden. Elevated blood-soluble urokinase plasminogen activator receptor (suPAR) has previously been shown to be associated with risk of intubation in confirmed COVID-19 patients. Objective: To evaluate whether point-of-care measures of suPAR in patients presenting to the emergency department (ED) with symptoms of COVID-19 can identify patients that can be safely discharged. Methods: Observational cohort study including all patients in the ED with symptoms of COVID-19 from March 19 to April 3, 2020. SuPAR was measured at first presentation. Review of electronic patient records 14 days after admission was used to assess disease trajectory. Primary endpoints were mild, moderate, severe, or very severe trajectory. The predictive value of suPAR, National Early Warning Score (NEWS), C-reactive protein (CRP), and duration of symptoms was calculated using receiver operating characteristics (ROC). Results: Of 386 patients, 171 (44%) had a mild disease trajectory, 79 (20%) a moderate, 63 (16%) a severe, and 73 (19%) a very severe disease trajectory. Low suPAR was a strong marker of mild disease trajectory. Results suggest a cut-off for discharge for suPAR < 2.0 ng/mL if suPAR is used as a single parameter, and <3.0 ng/mL when combined with NEWS ≤ 4 and CRP < 10 mg/L. Conclusion: suPAR is a potential biomarker for triage and safe early discharge of patients with COVID-19 symptoms in the ED. suPAR can be used even before SARS-CoV-2 status is known.

OriginalsprogEngelsk
TidsskriftJournal of Emergency Medicine
Vol/bind61
Udgave nummer3
Sider (fra-til)298-313
ISSN0736-4679
DOI
StatusUdgivet - 2021

Bibliografisk note

Funding Information:
We wish to thank all staff and patients at Copenhagen University Hospital, Hvidovre involved in this study. We thank Marianne Falck for excellent technical assistance, Linda Camilla Andresen for effective coordination and organization, and Dea Ravn for assistance with data management. LJHR was supported by a postdoctoral fellowship through grant R288-2018-380 from the Lundbeck Foundation. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. JEO is a co-founder, shareholder, and CSO of ViroGates. JEO and OA are named inventors on patents on suPAR. The patents are owned by Copenhagen University Hospital Hvidovre, Denmark and licensed to ViroGates A/S.

Funding Information:
LJHR was supported by a postdoctoral fellowship through grant R288-2018-380 from the Lundbeck Foundation. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Publisher Copyright:
© 2021 Elsevier Ltd

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